Ask Dr. Barber

Q. I read about a new saline implant in your Q&A article in this magazine a few years ago called the Ideal Implant. I am interested in a breast augmentation and it sounds like a good alternative to silicone implants. However, at the time I read the article they were very new to the market and I was worried that they had not been in use long enough to know for sure that they are safe. Are you still using these new saline implants and if so, do you think they are good implants?

A. The implant that you are referring to is called the structured saline implant and is manufactured in Wisconsin by a company called the Ideal Implant Company. The implant design is unique to breast implants and reduces one of the major issues of saline implants, implant rippling, which can be palpable on the surface of the breast. I am still using this implant and now have more than three years’ experience with the Ideal Implant and have over one hundred patients who have chosen it. The more that I use it, the more I believe it is an excellent alternative to the silicone gel implant and the standard saline implant. However, not everyone needs to use this implant. About 25% of my patients are still very good candidates for the standard saline filled implant, which has the advantage of being less expensive than the Ideal implant. The remaining 75% of breast augmentation patients are better candidates for either the Ideal implant or silicone gel implants. The best candidate for the Ideal implant is someone who has small breasts (B cup or smaller) and does not want to use a silicone gel implant. There are some advantages of the Ideal implant over the silicone implant, including less likelihood of hardness (capsular contracture), ease of diagnose of a leaking implant, and less risk of visible or palpable rippling on the skin surface of the breast when compared to standard saline implants. It is important to know that a leaking implant is not really a complication but more of an expectation after a certain amount of time that the implant has been inside your body. All implants, saline and silicone gel, given enough time will eventually fail. With any saline containing implant, it is much easier to know when the implant has leaked because the saline (salt water) will be absorbed and then excreted from the body and the breast will get smaller. With a silicone gel implant, the leaked silicone will not leave the breast so there will not be any change in the size of the breast. The only accurate way to determine that the silicone implant has leaked is to perform an MRI. The other advantage of the Ideal implant is less frequency of hardness of the breasts that occurs as a result of scar tissue that forms around the implant. So as you can see, there are some advantages to using the Ideal implant which, in my opinion, is an improvement over the standard implant and the silicone gel implant.

Q. I am almost fifty and have been using both Botox and fillers for my facial wrinkles for almost 8 years. I love the effect as it smooths my forehead lines and the fillers fill in the lines around my mouth. I am just a little concerned that I have been using these injectables for so long and I cannot find any information as to whether it is dangerous to be on these products for a long time. What is your opinion?A. Great question, and one that we do not get asked about very often. The simple answer to whether long term use of neuromodulators such as Botox Cosmetic® and Dysport is safe is yes, they are. There are many patients who have been using these products for more than 20 years for the treatment of blepharospasm and strabismus. (Read More)

Q. I desperately want a breast reduction and have even been approved by my insurance company for coverage of the procedure, however, I am so hung up on the potential risks of being put to sleep that I just cannot convince myself to proceed with the surgery. I would like to know your opinion regarding the safety of anesthesia for breast reduction surgery.

A. Breast reduction surgery can be a life changing procedure, and the fact that you are concerned about the anesthesia risks is not that unusual. I cannot count the number of patients who tell me that they are not worried about their surgery, but they are very fearful of the anesthesia. I suspect that there are many reasons for this fear, but probably the most common reason is the fact that you are giving up total control of your life to someone else. (Read More)

Q. I have dark circles under my eyes that make me look tired. Is there anything that can be done to lighten my eyelid skin?

A. Dark circles under the eyes are most commonly caused by shadows that are cast in the hollow portion of the “tear trough” of the lower eyelid. Many patients have puffiness of the lower eyelid caused by fat pockets. This puffiness accentuates the groove that is just below the puffiness and it casts a shadow in the groove. (Read More)

Q. I had a facelift about two months ago and I can still see my scars in front of my ears. I am worried that they will be permanent. What should I do?

A. First of all, relax. I am sure that your doctor told you that it can take months for scars to mature and “fade away”. It has only been two months for you, and that is not enough time for the scars to become inconspicuous. (Read More)

Q. I grew up on the coast of North Carolina spending way too much time in the sun. I now have numerous scaly spots on my face and recently had a skin cancer removed. I have read about a cream that can be applied to the face to remove some skin cancers and the scaly spots on the face. Do you know anything about this? The cream is called Efudex.

A. I am familiar with this cream, although it is usually prescribed by dermatologists. Efudex or Fluorouracil is a drug that has many uses, but when applied to the face in cream form will create a very significant inflammatory response. (Read More)

Q. When I was 39 years old (12 years ago), I had breast cancer and had a mastectomy with immediate reconstruction using tissue from my tummy. My reconstructed breast is doing just fine but my problem is that over the last 12 years I have gained some weight and my natural breast is now larger and droopier than it used to be. So unfortunately, my breasts do not match anymore. Is there a way to make them more symmetrical? I am very self-conscious when I put a bathing suit on because the difference is very noticeable.

A. First, congratulations on 12 years of beating breast cancer. This disease which has plagued women (and to a lesser extent men) since the beginning of time is so treatable when caught early. You are proof of that. (Read More)

Q.I had a breast augmentation 9 years ago. I have silicone gel implants. One of my breasts is literally as hard as a rock and looks misshapen. I have not been back to a plastic surgeon because I had the surgery in another state. What is going on with this breast, and can it be fixed?

A. What you describe is a classic condition of a capsular contracture of the breast implant. This is a situation where the body reacts to the implant, which is a foreign body, by forming a thick, tight internal scar around the implant. This condition occurs more commonly in silicone gel implants (up to 15% risk) compared to saline implants (3%-5%). (Read More)

Q. I had a breast augmentation last December. My right nipple area is completely numb. My left side is fairly normal. My surgeon said that the numbness will get better, but it has been four months and no change. What is your experience with loss of sensation in that area?

A. Numbness of the nipple-areolar area following breast augmentation is very common. I advise my patients that they can expect numbness that can last up to a year after surgery, although most of the time the sensation is back after a few months. (Read More)

Q. I have been keeping up with some of the reports on the association between textured surface silicone implants and the occurrence of breast lymphoma. I have discovered that the implant type that is most associated with this disease is the implant that I have. I am so worried now and wonder if I should have my implants removed?

A. That is a very good question, and I will say at the outset that there is not 100% agreement as to what to do for women in your situation. What you are referring to is a relatively newly recognized disease called breast implant associated anaplastic large cell lymphoma (BIA-ALCL). This disease is a malignancy that originates in the breast of women who have textured implants. (Read More)

Q. I was recently diagnosed with a malignant melanoma on my shoulder. My husband found it and I unfortunately just watched it for a few months before going to the dermatologist. She biopsied it and ultimately removed it. I was lucky because it was called a superficial melanoma and the only treatment recommended was close follow up for the next five years. I was advised to use sun screen regularly, but I am wondering if there is anything else that I can do and how do I protect my children from this terrible skin cancer?

A.Yes, you are very lucky. Malignant melanoma is now almost epidemic in the sun belt of the United States and I have witnessed over my 30-year career a dramatic rise in the diagnosis of this often aggressive and potentially fatal skin cancer. Part of the problem has been the rise in the use of tanning beds in the last 25 years and part of the problem is the failure of our population to be serious about sun screen when exposed to the sun for longer than about 15-30 minutes. (Read More)

Q. I am a 46-year-old healthy woman who has inherited from my father a neck that has no definition and seems to be full of fat. On a picture of my profile it is hard to tell where my face ends and my neck begins. I have had this neck for about 15 years, but it has gotten worse since I had children and gained some weight. Is there anything that can be done to restore some definition to my neck?

A. Developing skin laxity in the neck and slowly accumulating some fat in the neck is not unusual as we age. When these changes occur, there is a loss of the tight angularity of the neck that is characteristic of the youthful neck. What you are describing is more of a hereditary condition where there is too much fullness of the neck at an earlier age. This exaggerated amount of excess skin and fat blurs the transition from the lower face to the upper neck. (Read More)

Q. About a year ago, I had an upper eyelid lift by a plastic surgeon outside of Greensboro. Everything seemed to have gone well after surgery except that I am still not able to completely close my eyelids together. There is a gap between each upper and lower eyelid when they are supposedly closed. I really cannot see the gap myself, but my husband says it is very noticeable when I am asleep. In addition, my eyes are always dry, and I am constantly having to use drops to moisten them. My plastic surgeon says that it will eventually get better and that there is nothing that needs to be done about the issue. Is there anything that I can do to help this problem?

A. The condition that you are describing is called lagophthalmos, and is a known risk of performing an upper eyelid blepharoplasty. This condition is a complication related to over resection of the upper eyelid skin. This over resection makes the upper eyelid too tight, resulting in the inability to completely close the eyes. The most common indication for an upper eyelid lift is because there is excess eyelid skin, which makes the upper eyelids look heavy and tired. (Read More)

Q. I am contemplating a breast augmentation in the next year or so. I am researching implant options and I remember reading in Kernersville Magazine a year or so ago about a new implant called the Ideal Implant. Can you tell me if you have experience with this implant and if you think it is a good alternative to the silicone gel implant?

A. Yes, I do have experience with this implant and I do think it is an excellent implant that can be an alternative to the silicone gel implant or the standard saline implant. The Ideal Implant was FDA approved several years ago and became commercially available just over 2 years ago. (Read More)

Q. I had a breast augmentation about 10 years ago. I am older now and having large breasts is not that important to me. I am a long distance runner and the implants just seem to get in the way when I run. I would like to have them removed but I have read online that removing without putting another implant back in will cause distortion of the breasts. Is it true and is it possible to take my implants out?

A.Yes your implants can be removed and in most instances distortion of the breasts does not occur after removal. If you have saline implants, then removal is typically performed in the office under local anesthesia with oral anesthesia (Valium), with only minimal downtime. You can expect to return to work the next day but I ask patients not to jog for at least one to tow weeks after explantation. (Read More)

Q.I am in my mid-twenties and I was born with a cleft lip. My lip was repaired when I was a baby and it looks fine to me. However my nose does not look normal and I was wondering if there is anything that can be done to improve its appearance? I have never had any surgery on my nose as far as I know, unless something was done when I was a baby.

A. Of course, there is something that can be done to improve the appearance of your nose, but you should be seen by someone who specializes in what we call a “cleft-lip nose”. A cleft lip nose can be very noticeable in some, yet exhibit only minor deformities in others, and the difference is usually related to the severity of the original cleft lip. It is unlikely that any corrective surgery has ever been done to your nose, since it is rare to operate on a baby’s nose while it is still developing. (Read More)

Q. I am the mother of 4 children and nursed all of them for nearly a year each. I have small breasts but my nipples are too big and honestly just look like they are stretched out. They were not like that before I had children so I think it is related to four years of nursing. Can this be fixed?

A. Yes, yes, yes. You have what is called nipple ptosis. It absolutely was caused by 4 years of nursing. The procedure to correct the problem is relatively simple. The reason nipple ptosis occurs is that the nipple gets stretched by the nursing baby. This creates the problem that the base of the nipple no longer has the tissue strength to support the nipple, so it basically just hangs down. (Read More)

Q. I had a face lift about 15 years ago and have been very happy. However, my cheeks are again beginning to sag, especially in the jowl area. I am 68 years old and do not think I want to go through another face lift. Is there an alternative to a full face lift to re-tighten my relaxed cheek skin?

A. Assuming that you are healthy, there may be a couple of options for you. If you have recurrent laxity of the skin in the cheek and jowl area, then probably the best choice for you is to undergo a cheek lift. A cheek lift is not as aggressive as a full face lift and the goals of a cheek lift are more limited. A cheek lift will tighten the jowls, re-establish a nicer jawline, and soften the nasolabial fold. The nasolabial fold is the crease between the corner of the nose and the corner of your mouth. The cheek lift will not significantly improve any skin laxity of the neck, if there is any present. The surgery to tighten the cheek can be performed under local anesthesia and a little Valium by mouth or heavier sedation if you so choose. (Read More)

Q. I have heard that there are some technologies that will tighten the skin of the neck and face so that a face lift can be avoided. Is this true and does it work well?

A. The answer to your question is that there is a technology that has been developed to tighten skin. It uses radio frequency waves to create heat which contracts the skin. (Read More)

Q. I have heavy upper eyelids with too much skin hanging down. How can I find out if my insurance will pay for an upper eyelid lift?

A. There is a very simple and painless test that ophthalmologists perform in their office called a visual field test. It will measure whether the redundant upper eyelid skin is obstructing your peripheral vision or not. (Read More)

Q. I am contemplating having fat injections in my buttock area. I have seen a surgeon who has scheduled my surgery. However, I recently read some reports about problems with butt lift procedures using fat. Before proceeding, I just want to make sure the procedure is safe. What is your opinion regarding a Brazilian butt lift with fat?

A. Like all elective surgical procedures in plastic surgery, a butt lift is generally considered safe, however there are potential risks that one takes when undergoing this surgery. Brazilian butt lifts have become quite popular, especially in South America but also, to a lesser extent, in the United States. The number of these procedures being performed in this country has been steadily rising over the last ten years. The procedure involves transferring fat from one part of a patient’s body to the buttock area. The fat is first harvested by way of liposuction of, for example, the abdomen, love handles, hip rolls, and thighs. The fat is cleaned and then concentrated by removing fluids. Once the fat has been prepared, it is reinjected in the buttocks. The harvesting of the fat is performed in a very traditional fashion using standard liposuction. This part of the process is considered very safe with limited risks. (Read More)

Q. I would like to know when I should replace my breast implants. I had an augmentation about 10 years ago in another state. I know that I have saline implants but do not know anything else about them. When should I plan to replace these implants?

A. This is a good question and one that I face every day in my practice. Before I answer your question about when to replace a breast implant, let me say that you should make an effort to get as much information as you can about your implants from the doctor that placed them. Most plastic surgeons will keep breast implant records for many years. It is always good to know the manufacturer of your implants, the size of the implants, the date of placement of the implants, and whether the implants are under or on top of the muscle. This information will be of great benefit to the plastic surgeon who may be replacing them in the future. Also, if the implant is leaking, the manufacturer will often provide new implants at no charge, so knowing the manufacturer is beneficial to you. (Read More)

Q:I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”?

A: What you describe is called a capsular contracture and is caused by aggressive scarring that has formed around your implant. It is not known exactly why contracture forms in a woman’s breast but it is postulated, and evidence is beginning to support, that hardness is caused by a bacterial infection around the implant. The infection is sub-clinical, meaning that it does not cause any symptoms such as fever, swelling, redness, or pain. (Read More)

Q:I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth?

A: It is difficult to completely eradicate fine lines on the face, but there are certainly some non-surgical options that will improve the skin. First and foremost, start protecting your skin against further damage with regular application of a good broad spectrum higher SPF (above 35) sunscreen. This one step in your daily skin care regimen is the most important thing that you can do, both to reduce additional premature aging and to protect your skin against skin cancer, which is epidemic in the South. (Read More)

Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount.

A. First, let me say that it is OK to go into the sun but you must protect yourself with a good sunscreen. It is so common for me to hear how careful patients are protecting their face, but they forget to put sunscreen on their chest. So as a result, some of the worst sun damage I see in my practice is in the décolletage area. (Read More)

Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common?

A. Online sources of information can sometimes be misleading, but in this case the information that you read is correct. Blindness is a potential, albeit rare, risk with any injectable into the face. It is most associated with hyaluronic acid fillers, such as Juvederm® and Restylane®. (Read More)

Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route?

A. I applaud you for having the gene test for breast cancer. You now can take some control over the disease rather than the disease having control of you. As you have probably been informed, there are two genes that are commonly evaluated to see if a patient has an increased risk of breast cancer, BRCA1 and BRCA2. BRCA is an abbreviation for BReast CAncer. (Read More)

Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?

A. There is no absolute science to picking a good doctor in any specialty. Fortunately, in plastic surgery most everything is somewhat elective and you at least have time to investigate your choices and visit several plastic surgeons before making a decision. You did not say what kind of eye surgery you are contemplating, so I am assuming that it is some type of cosmetic surgery of the eyelids. My suggestion is to first ask your primary care doctor to give you a list of 2 or 3 plastic surgeons who he/she would recommend. (Read More)

Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it.

A. It is not unheard of to have some loss of hair in the temple area after a facelift. The hair loss is generally due to tension caused by the pulling of the skin when doing the lifting of the face. If the tension at the incision is significant enough, it can reduce the circulation of blood to the skin around the incision. Hair follicles are very sensitive to reduced blood flow and can result in the hair bulb, where the hair grows, dying. This leads to a bald spot. (Read More)

Q. The hole in my earlobe where my earring sits has gotten progressively larger over the years. My earring now does not sit nicely against the earlobe but hangs down. Can the hole in the earlobe be made small again?

A. Yes, it can. It requires a small surgical procedure to remove the enlarged hole and suture the skin back together again. The repaired earlobe hole is allowed to heal for about three months, then the lobe can be re-pierced. The procedure is performed under local anesthesia and has no down time after the repair. The key in the future after re-piercing is to not wear heavy earrings that pull on the hole causing it to elongate again.